To Ve or not to Ve? THAT is the question?!

It is, the textbooks, Denis Walsh, Soo Downe etc are great, I have had quite a few lectures from them and they are inspirational, and no matter how strong/couragious and passionate you are it i difficult for you to tell a doctor/senior midwife (even midwife at that) not to examine a woman as you feel she is coping well good FH etc etc.. but the system is archaic, there is quite often someone breathing down someone elses neck/demanding answers, thus is escalades down to you, to comply (cry) whatever really, I don't want to regularly examine women, but there again I am not confident enough in practice as yet to completely rely on intuition/other senses to assess progress as yet (hopefully my elective placement may aid this), but I am willing and ready to learn x

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Have you just been offered a place? If so and you want a mentor please post in post this forum (also post here if you would like a mentee)

I think we need more training with independent midwives..... I feel that the environment we are in stifles our learning in lots of ways because its not just about learning its about negotiating the politics of policy and environment too.... my friend who was 100% committed to midwifery and had been for years left in year 2 as she couldnt handle the environment.

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StudentMidwife.NET Founder & Director

What do we live for, if it is not to make life less difficult for each other?
(George Eliot, 1860)

Unfortunately, the chances of that happening is pretty remote soon enough, unless a bloody miracle happens.

Or get big bolts on the del room doors, and brave the consequences afterwards!!!

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Have you just been offered a place? If so and you want a mentor please post in post this forum (also post here if you would like a mentee)

There has to be a way!! I personally think I would learn alot more 121 in that kind of environment.

LE do you know what it is that prevents it? is it insurance? is it that its just not 'in' the midwifery ed programme?...

I feel a new campaign coming on..

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StudentMidwife.NET Founder & Director

What do we live for, if it is not to make life less difficult for each other?
(George Eliot, 1860)

TallPoppy, I have started the course - don't be deceived by my moniker. I've also worked in a consultant-led unit prior to starting the course, so I'm well aware of what goes on in real life. In fact, working there has given me a bit of an idea about how I might approach the inevitable tensions when I return there on placement. (Luckily, community comes first where I am!)

As far as I am aware, it is part of an EU directive. The independent midwives will not be able to practise unless we become insured, come 2009/2010. At present we can obtain insurance for post natal / ante natal care / classes through the RCN. Noone is willing to cover indies for intrapartum care. Come 2009/ 2010, unless indys have insurance, they will not be able to register as midwives. I am assuming they can remain on the register if they have RCN cover but there will be restrictions placed as far intrapartum care is involved.

There are talks of contracting in to the PCTs, I can't see how that might work, and I am also aware of the clock ticking - 18 month is a short time to organise something as major as contracting in with individual PCTs. But I do believe in miracles at time.

I suppose one could bury one's head in the sand a la ostrich and hope that once the legislation kicks in, the insurance companies will then be interested in coming up with some insurance deal. Again, that is the sort of wait and see approach that doesn't really agree with some people.

As to campaigning about it, there is a campaign in existence anyway. There have been protests and a lot of media involvement. However, this is a legislation that has been brought in.

Ok, you fooled me! LOL

All tension tips welcome

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StudentMidwife.NET Founder & Director

What do we live for, if it is not to make life less difficult for each other?
(George Eliot, 1860)

Thanks LE, I am aware of the Save Independent Midwifery campaign, is that the one you refer to?

Thanks for the low down. I was thinking more of a campaign to get us placements with independent midwives instead of just two week electives... We sould have a module ideally, but then I guess being funded by the NHS they may not like that idea... still I think we should have more access for IMs .... and birth centres....

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StudentMidwife.NET Founder & Director

What do we live for, if it is not to make life less difficult for each other?
(George Eliot, 1860)

I think the point is that you WILL do things that you don't agree with, just because of the situation you are in. It doesn't have to infiltrate your soul, as long as you don't lose your awareness of this. That means living with the pain of your actions too.

However, I think you can model good practice, even when you are under the supervision of a mentor. For example, with VE. NICE guidelines say (from memory, forgive any inaccuracies) *offer* vaginal exam as part of the initial assessment. Every 4 hours (in established labour) check BP, temperature and *offer* vaginal exam.

When you have to *offer* a VE, tell the woman what you would be doing it for and why, include her as a partner in the decision of whether it should be done. At the very least it will make it a choice, rather than just something that is done to her "with consent" (which is little more than documenting that we have achieved compliance). It is very unlikely that she will decline VE, but you are developing skills for talking to women about the need (or not!) for VE.

Always, but always, palpate abdominally and get maximum information that way before doing any VE. Your mentor may not always be this thorough herself, but no mentor is going to criticize you for doing it. (Or if they do, they are miserable old bats). Don't say "I just like to do it *properly*" (implying that mentor does it "wrong"), just don't comment on the differences in the way you do it. Or if mentor comments, just say something like "I just feel more confident when it comes to VE if I've already got a clearer idea from palpation". Define position on palpation, use a pinard to hear position of FH, define descent. Try to deal with any discrepancies between your practice and that of your mentor as non-confrontationally as possible. If you mentor has a "go" about something you do, don't argue the toss with her - it's not about 'winning the argument', you are in self-preservation mode at that point. "Okay, that's given me a lot to think about/get my head around" is an excellent way out without conceding the point! (And you never know, on reflection your mentor might be right!) Don't say "But, so-and-so said it was okay". Don't allow compromise over one area of practice to affect every little bit of your practice with that mentor. You never know, she might have a "thing" about one practice (perhaps as a result of experience in the past - early pushing urge for example) but be more open-minded in another area.

Don't do anything you feel is positively dangerous. You really HAVE TO stand up, sit down, walk away, whatever...if it comes to that. But even so, there are ways and ways of extricating yourself from the situation without confrontation. For example, on the basis of knowledge up to now, I would not routinely feel for cord, but would feel for cord if mentor had a "thing" about it. However, if I felt a cord and was told to clamp and cut before shoulders, I would forgo the delivery rather than do it, perhaps saying "I don't feel confident doing that, can you take over" and stepping out of the way. It's better to be thought a total idiot by your mentor than do something that you think is positively harmful. The cord will still be clamped and cut prior to shoulders, but at least you won't be responsible! Or perhaps in the time it takes for the mentor to step in, the shoulders will delivered anyway, through the cord. That's just an area I've thought about, I expect everyone can think of others.

Go to a Denis Walsh study day (unless he happens to be one of your lecturers, in which case, what can I say - lucky you!) One of the top things you will learn by going is who are the midwives in your unit who are interested enough in normal birth to get themselves along to a study day like that! Try to build relationships with the 'pro-normal' midwives.